Friday, November 9, 2007


It's a balmy June afternoon when a young man is rushed into the ER with superficial but not deep burns. You see this on his back. This feathering skin injury is pathognomonic for this case, but will fade within hours. You immediately stick EKG leads on this patient as he is at risk for cardiac arrhythmias. He mumbles that he was "just playing football when it happened."

Challenge: When what happened?

Related Questions:
1. What's the finding in the image?

(I have to say I'm particularly proud of discovering this one. I think it's really cool.)

Image shown under fair use.


Alex said...


Craig said...


The image shows a branching cutaneous Lichtenberg figure or flower, also called filigree burns, keraunographic markings, or arborescent burns (though they are not true burns). This is diagnostic of being struck by lightning. The epidemiology of lightning-related fatalities indicates it is most common May-September (92%), afternoon or early evening (72%), while people are engaged in outdoor recreational activities (>50%). Most victims are young men.

Lightning injury is related to superficial surface burns, but not deep burns due to short duration of contact and “flashover effect” (current travels on the skin surface and is discharged to ground). Other organ systems that may be affected include cardiac (arrhythmias), musculoskeletal (especially periosteal burns), renal (due to rhabdomyolysis), and CNS.

Source: UpToDate, Wikipedia.

Alex said...

lightning can also demarginate all your neutrophils. that would've been a cool (albeit strange) case, leading to presumed leukocytosis.